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Saving Entitlements: Make 60 the New 70

More interesting than how Candy Crowley might moderate tonight’s presidential town hall debate, which follows on the heels, of course, of last week’s vice presidential debate, is whether Crowley’s age – 63 – might impact her views about Social Security or Medicare.

Sorry, Candy, but in today’s open communication world, I was tooling around the Internet and came across your age. What interested me is not so much how old you might be, but exactly how active and engaged you are at a moment in life that was formerly believed to be a time for dependency, retirement – or, worse – knitting or golf.

Here’s the question for the country right now: How can an age-related entitlement society survive in an era of aging populations? And here’s an answer: It can’t, if we define “old” as 60, 65, or even 70. This has to change.

In the next two decades, 77 million baby boomers will pass through our traditional notion of retirement age, and the demand on age-related entitlements will skyrocket. Both vice presidential candidates, Joe Biden and Paul Ryan, conceded that reform is essential, but neither of them in last Thursday’s debate or during the political discourse in general have addressed the far more relevant point: This is less about the number of older people passing through retirement now than it is about a profound structural shift in our societies that will very shortly have more citizens over the age of 60 than under the age of 15.

We need to begin to make real change for a new century. How can old-age entitlements be kept alive and available for those who need them? How can we create reforms so that limited funds go to those in need? The answers to these vital questions go hand-in-hand with the responses to today’s urgent fiscal cliff.

Tinkering with the supply (the entitlements themselves) will not work – so, instead, the answer must be to lower the demand (the seniors who need help). This begins to guide us in terms of how we spend our money or target our policy incentives to encourage market shifts.

The only way to do this, to “save Medicare,” as the refrain goes, is to keep adults healthier as they age, even as we redefine at what age those “benefits” kick in. And it is true that keeping 60, 70 and even 80-year-olds active is largely correlated with healthy aging.

A recent report by The Economist Intelligence Unit offers fascinating solutions. The report, “Preventive Care and Healthy Ageing: A Global Perspective,” shows how the health care costs of older adults declines after making strategic investments in health and wellness. Investments up front in preventive care, the report argues, can create savings “up to a fourfold return on investment.”

It’s a two-tiered win, as the report notes. Investment in preventive care decreases health costs, which creates immediate relief for strained entitlement systems. And it increases the health of older adults, which creates residual relief for the long term by keeping people productive longer.

We can make a strategic preventive investment in a number of ways. One promising pathway: adult vaccinations. In most of the world, it’s become common practice (and common sense) to vaccinate children. But “adult vaccinations” remain rare. Despite guidance from the World Health Organization, countries around the world do not adequately vaccinate adult populations. The result: Millions of older adults suffer and often die from diseases that could be prevented by cheap, scalable vaccinations.

The Economist, quite rightly, calls adult vaccinations “low-hanging fruit.” What it needs now is political pickup – as well as investments in other big health challenges that correlate with the economic interests of older societies (Alzheimer’s, diabetes, cardiovascular disease, stroke and more) to reduce costs down the road. We also need investments in the more subtle impacts of aging – vision and mobility loss. That would help keep people considered dependent today much more active and productive (and less in need of entitlements as they age).

For the U.S., and for all other nations struggling with these issues, the solution is counter-intuitive. Investments must be made in health and wellness to prevent the short- and long-term demands on Medicare. Politically motivated cuts and vouchers are only going to band-aid the system. What must change profoundly are the needs of the aging population – and a culture shift in how we perceive “old.” Let’s hope the politicians pick up on this.

Michael W. Hodin, Ph.D., is Adjunct Senior Fellow at The Council on Foreign Relations, and Executive Director of The Global Coalition on Aging.